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UNDERGROUND ST RAGE TANK <br /> SECONDARY CONTAINMENT TESTING REPORT FORM (Page 5 of 6) <br /> XVII . FILL RISER SUMP TESTING INFORMATION <br /> Manufacturer Identify Tank ID from section III for each Manufacturer <br /> Xerxes A ® B ® CO D ❑ <br /> A ❑ B ❑ C ❑ D ❑ <br /> Test Method Used : <br /> ❑ Manufacturer Guidelines : (Specify) <br /> ® Industry Code or Engineering Standard : (Specify) PEI RP1200 <br /> ❑ Engineered Method : (Specify) <br /> # of Attached Pages <br /> Attach the testing procedures and all documentation required to determine the results. <br /> Fill Riser Sump Testing Training and Certifications (List applicable certifications) Expiration Date <br /> Xerxes 12/27/21 <br /> XVIII , COMMENTS <br /> Provide any additional comments here. <br /> XIX . VENT / TRANSITION PIPING SUMP TESTING INFORMATION <br /> Manufacturer Identify Vent / Transition Sump ID from <br /> section III for each Manufacturer <br /> a ❑ b ❑ c d <br /> a ❑ b ❑ c ❑ d <br /> Test Method Used : <br /> ❑ Manufacturer Guidelines: (Specify) <br /> ® Industry Code or Engineering Standard : (Specify) <br /> ❑ Engineered Method : (Specify) <br /> Attach the testing procedures and all documentation required to determine the results. # of Attached Pages <br /> Vent I Transition Piping Sump Testing Training and Certifications (List applicable certifications) Expiration Date <br /> i <br /> XX. COMMENTS <br /> Provide any additional comments here. <br /> ID = Identification <br />�I <br />